Prevalence and types of childhood trauma in first episode psychosis patients. Relation with clinical onset variables.

OBJECTIVE: To study the prevalence and the type of childhood trauma (CT) in a first-episode psychosis (FEP) cohort and in a healthy control (HC) sample. To study which clinical and sociodemographic variables in the onset of the FEP are related to having suffered some traumatic experience in childhood. METHOD: 100 FEP patients and 94 HC participated in the study. The Childhood Traumatic Questionnaire (CTQ) was used to evaluate CT. The Positive and Negative Syndrome Scale (PANSS), the Personal and Social Performance (PSP), the Suicide Risk Scale of Plutchik (SRSP), and the Perceived Stress Scale (PSS) were also administered. RESULTS: 61% of FEP patients and 17% of HC reported having experienced some kind of CT. FEP showed more CT than controls in all subscales, except in sexual abuse. The most frequent CT was emotional abuse. For the FEP group, younger age, more years of education, have a first-degree family history, more positive and negative symptoms, more perceived stress and more personal and social functioning were the variables more influenced by having suffered some kind of CT. CONCLUSIONS: There is a high prevalence of CT in FEP patients. Having a first-degree family history of mental illness, more positive symptoms, and more perception of stress at the time of hospital admission were related to having suffered CT. More research is needed to find out the best way to detect CT and its role in psychosis to be able to implement interventions to improve the evolution of these patients.

Higher light intensity and mat temperature attract piglets to creep areas in farrowing pens.

Loose farrowing pens have been considered as alternatives to crates to enhance sow welfare. A major concern with pen systems is often higher piglet pre-weaning mortality, especially due to crushing by the sow. An optimal management of light and mat surface temperature may promote greater piglet use of the creep, which has been associated with reduced piglet crushing. A total of 108 sows and their piglets were studied in sow welfare and piglet protection pens on a commercial piggery, across two replicates. Sows were randomly assigned to pens arranged within two creep treatments (bright creep: 300 lx v. dark creep: 4 lx), considering mat temperature as a covariate. Twelve sows and their litters in each treatment (24 in total) had their behaviour continuously recorded for 72-h postpartum (pp), and four focal piglets per litter were weighed on the first and third days pp. In situ behaviour observations were performed daily (from 0800 to 1700 h) on all sows and their litters, every 15 min over 72-h pp to record piglet time spent in the creep, latency to enter the creep for the first time, latency for the litter to remain in the creep for at least 10 min, and piglet and sow use of pen areas immediately in front of (A2) and farthest from the creep (A3). Piglets with access to bright creeps spent on average 7.2% more time (P<0.01) in the creeps than piglets in pens with Dark creeps. In addition, for each degree increase in mat temperature, piglets spent on average 2.1% more time (P<0.01) in the creep. Piglets in pens with bright creeps spent less time in A2 (P=0.04) and the least time in A3 (P=0.01). Light or mat temperature did not affect sow use of pen areas or piglet weight gain. Piglets with bright creeps tended (P=0.06) to take longer to enter the creep for the first time after birth, but the latency for 30.0% of the litter to remain clustered for 10 min tended (P=0.08) to be shorter in bright compared to dark creeps. Overall, piglet use of the creep increased with warm mat temperatures and brightness, which should be further investigated as potential strategies to promote piglet safety and reduce crushing in pen farrowing systems.

Determining the effects of early gestation in utero heat stress on postnatal fasting heat production and circulating biomarkers associated with metabolism in growing pigs.

The study objective was to characterize effects of early gestation in utero heat stress (IUHS) on postnatal fasting heat production (FHP) and blood biomarkers associated with metabolism in growing pigs. Based on previous observation of increased postnatal core body temperature set point in IUHS pigs, we hypothesized that FHP would be altered during postnatal life because of IUHS. Pregnant first-parity gilts were exposed to thermoneutral (TN; = 4; 17.8 ± 0.1°C) or heat stress (HS; = 4; cyclical 28 to 38°C) conditions from d 30 to 60 of gestation. At weaning (21 d of age), 2 median-weight male pigs (1 barrow and 1 boar) were selected from each litter ( = 8 in utero TN [IUTN] and 8 IUHS pigs) and then housed in TN conditions based on age. Blood samples were collected at 8, 9, and 10 wk of age when pigs were in a fed state to analyze thyroxine (T4) and triiodothyronine (T3) concentrations. Pigs were trained to enter an indirect calorimeter from wk 8 through 10 of life and then acclimated over a 24-h period 1 wk prior to testing. At 12 wk of age, pigs were fasted for 24 h, and then indirect calorimetry was performed on individual pigs over a 23-h testing period to determine FHP and the respiratory quotient in 3 intervals (0900 to 1700 h, 1700 to 0000 h, and 0000 to 0800 h). Body weight was determined before and after testing and was similar for all pigs ( = 0.77; 37.0 ± 0.5 kg BW). Data were analyzed using PROC MIXED in SAS 9.4. No boar vs. barrow differences were observed with any analysis. Overall, FHP per kilogram BW was greater ( = 0.03; 12.1%) in IUHS pigs compared with IUTN pigs. Fasting heat production per kilogram BW was greater ( < 0.01; 19.8%) from 0900 to 1700 h compared with 1700 to 0000 h and 0000 to 0800 h and was greater (10.9%) from 1700 to 0000 h compared with 0000 to 0800 h. The RQ did not differ by in utero treatment ( = 0.51; 0.72 ± 0.01); however, the RQ was increased ( < 0.01; 13.0%) from 1700 to 0000 h compared with 0900 to 1700 h and 0000 to 0800 h. No other FHP and RQ differences were detected. Although no in utero treatment differences were observed for T4 ( = 0.11; 52.2 ± 6.2 ng/mL), T3 was greater overall ( = 0.04; 19.5%) in IUHS pigs than in IUTN pigs. In summary, FHP and circulating T3 were increased in IUHS pigs, and this may have implications for postnatal production efficiency in pigs gestated during hot summer months.

Effect of N-acetyl-cysteine (NAC) added to fenoldopam or dopamine on end-tidal carbon dioxide and mean arterial pressure at time of renal artery declamping during cadaveric kidney transplantation.

N-acetyl-cysteine (NAC) is known to be a powerful antioxidant used to prevent renal damage. Our deceased-donor kidney transplantation protocol administered an NAC bolus at the time of declamping of the renal artery to reduce the potential oxidative damage with ischemia-reperfusion. The aim of injury this study was to compare the effects of NAC added to a continuous infusion of either fenoldopam or dopamine during kidney recipient anesthesia on mean arterial pressure (MAP) and end-tidal carbon dioxide (ECO(2)), which were assumed to be expressions of oxidative and acid-base status. One hundred forty patients undergoing deceased donor kidney transplantation were enrolled in the study. Using a standardized perioperative anesthesia protocol, the patients were divided into 4 groups: group N, receiving an NAC (50 mg/kg) bolus just before renal artery declamping (n = 40); group C, not receiving any NAC or other infusion (n = 20); group NF, same treatment as group N plus fenoldopam (0.1 microg/kg/min) continuous infusion (n = 40); and group ND, same treatment as group N plus dopamine (3 microg/kg/min) continuous infusion (n = 40). We recorded the duration of kidney cold and warm ischemia and EtCO(2) and MAP values before and after arterial declamping, as well as subjective evaluations of graft perfusion and the incidence of early or delayed graft function and adverse events. EtCO(2) was higher and MAP lower in group C compared with group N; comparing groups N, ND, and NF, the NF regimen resulted in lower EtCO(2) and higher MAP values and a greater incidence of early graft function. Subjective evaluation of graft perfusion was more favorable for groups N, ND, and NC, particularly for NF. No significant periprocedural adverse events were recorded in the groups. In our experience, the association of an NAC bolus at the time of renal artery declamping and continuous infusion of fenoldopam resulted in a minor, though non-significant, increase in EtCO(2) values, higher MAP, and greater incidence of early graft function during deceased-donor kidney transplantation compared with no NAC or NAC plus renal-dose dopamine. Further studies are necessary to better define the potential role of oxidative damage in renal ischemia- reperfusion injury, including implications for outcome, as well as the potential role of the combination of NAC plus fenoldopam as a nephroprotective and outcome-modulating regimen.

Uptake and distribution of labeled antibodies into pH-sensitive microgels.

We investigated the uptake and release of labeled antibodies from pH-sensitive hydrogel microparticles (i.e. microgels) by means of fluorescence analysis of labeled biological samples. The poly(methacrylic acid) (PMAA) hydrogel is a carbon-based network having carboxylic groups on the surface that dissociate according to their acid-base equilibrium. The ability of the PMAA microgel to encapsulate and release anti-CD4 and anti-CD8 monoclonal antibodies (MAbs), differing for the isotype and labeled with highly photostable fluorophore, was studied in solution by photoluminescence spectroscopy. The experimental results indicated that the uptake and release of the tested antibodies were controlled by pH. Furthermore, confocal microscopy analysis in the solid state revealed that the distribution of the labeled antibodies either on the surface or in the core of the microgel matrix was related to the specific properties of these MAbs.

Wound levobupivacaine continuous infusion for postoperative analgesia in living kidney donors: case-control study.

INTRODUCTION: The objective of this study was to evaluate the efficacy of an analgesic regimen based on levobupivacaine continuous infusion into the surgical wound of living kidney donors (LKDs). PATIENTS AND METHODS: Fifty adult LKDs (mean age, 53.1 +/- 5.3 years; age range, 52-68 years) were retrospectively assigned to a no wound infusion (NWI) group (n = 25) or a wound infusion (WI) group (n = 25). At the end of surgery, patients in the WI group received 10 mg intramuscular morphine; a peridural catheter was placed 10 cm between the intercostal muscles fibers close to the lower rib extremity, and a solution of levobupivacaine, 150 mg/100 mL, was started at 5 ml/h(-1). Patients in the NWI group received intramuscular morphine, 10 mg, every 8 hours; intravenous tramadole, 100 mg, was planned as a rescue drug for incidental pain. Pain was measured using a visual analog scale (VAS) ranging from 1 (no pain) to 10 (maximum pain) in both the basal condition (VASb) and during coughing (VASc) at 1 hour after leaving the operating room and 6, 12, and 24 hours thereafter. RESULTS: At 1, 6, 12, and 24 hours, VASb values in the NWI vs the WI group were 5.2 vs 3.1, 6.8 vs 4.1, 5.8 vs 4.9 (all p < .01), and 5.4 vs 5.1, respectively, and VASc values were 8.2 vs 6.3, 8.8 vs 5.9, 7.1 vs 5.3, and 6.8 vs 5.1 (all p < .01). Mean VAS score was significantly higher between 1 and 6 hours in the NWI group for all VASb measurements vs VASc values. Tramadole consumption was higher in the NWI group than in the WI group. CONCLUSIONS: Continuous wound infusion with 5 mL/h(-1) levobupivacaine, 1.5 mg/mL(-1), resulted in a safe and effective analgesic protocol in LKDs both in the immediate postoperative period and in the first day after surgery, a result that was more effective than a morphine-tramadole regimen. No adverse effects were recorded, which confirmed the safety of the technique. It is probable that better results could be achieved with dedicated administration devices.

Fenoldopam vs dopamine as a nephroprotective strategy during living donor kidney transplantation: preliminary data.

UNLABELLED: Fenoldopam is a selective DA1 agonist with potential nephroprotective capabilities. The aim of this study was to compare the nephroprotective effect of fenoldopam and dopamine during general anesthesia for living donor kidney transplantation. METHODS: Forty donors enrolled in the study received a similar anesthetic and fluid protocol. The patients were randomly divided into group F (receiving 0.1 mg*kg-1*min-1 fenoldopam) versus group D (receiving "renal dose" 3 mg*kg-1*min-1 dopamine). The mean volume of infused fluids, diuresis, and urinary electrolytes (Na, K, Cl) at infusion start and 120 minutes later were studied. RESULTS: Anthropometric parameters, administered anesthetics, mean infused volume, and urine outputs, did not show significant differences between the groups. Statistically significant differences were observed for urinary excretion of sodium, potassium, and chloride after 120 minutes of continuous fenoldopam infusion, with significant variations within groups for sodium only. CONCLUSIONS: Fenoldopam compared with dopamine resulted in better nephroprotective effects. No adverse events were recorded, and side effects were minimal. Further studies are necessary to evaluate these data.

Monolateral dual kidney transplantation from marginal donors.

BACKGROUND: Dual kidney transplantation (DKT) offers a safe way to face the organ shortage with good short-term and medium-term renal function. However, its application is limited by the longer operating time and the risk of surgical complication. This study reviews our results with DKT performed with an ipsilateral technique in terms of graft loss, graft and patient survival rates, and surgical complications. PATIENTS AND METHODS: From January 2002 to March 2006, 23 patients underwent DKT through a monolateral Gibson incision with placement of both kidneys. RESULTS: One primary nonfunction occurred (4%). Delayed graft function was observed in 3 DKT (13.3%). Acute rejection rate was 4.3% (1 patient). All patients are alive at a mean follow-up of 28 months. One-year and 2-year graft survival rates were 100% and 96%, respectively. Mean serum creatinine level at 1-year posttransplantation was 1.3 mg/dL (range, 0.8-2.1 mg/dL). One DKG recipient lost 1 graft, retaining the second normal functioning graft due to ureteral necrosis. The mean hospital stay after transplantation was 15 days (range, 12-34 days). CONCLUSIONS: Monolateral placement in DKT offers the advantage of a single incision, minimizing the surgical risk. Tailored immunosuppression and careful selection of potential recipients, by excluding those with severe cardiopulmonary pathologies, could significantly improve both patient and graft survival in this group of patients.

Voriconazole in the treatment of invasive aspergillosis in kidney transplant recipients.

BACKGROUND: Aspergillosis and other invasive mold infections are severe complications in immunosuppressed patients, and in renal transplant patients it is the most common cause of systemic fungal disease with an incidence ranging from 0.4% to 2.4% with a high mortality of 56% to 100%. We present our experience with voriconazole in a population of kidney transplant recipients with invasive aspergillosis. PATIENTS AND METHODS: From January 2002 to December 2005, 245 kidney transplantations were performed. RESULTS: Four patients (1.6%) presented with clinical and laboratory findings of invasive aspergillosis. Three patients presented with pulmonary aspergillosis, while one patient presented with pulmonary and ocular aspergillosis. All patients underwent a therapy with voriconazole 200 mg twice a day, in combination with caspofungin in one patient. All patients are alive, with no clinical recurrence of aspergillosis at a median follow-up of 13 months. One patient lost her graft due to discontinuation of immunosuppression. CONCLUSIONS: Voriconazole is a potent and well-tolerated antifungal drug that is extremely efficacious in the treatment of invasive aspergillosis in kidney transplant recipients. A careful monitoring of immunosuppressive drugs should be considered to avoid nephrotoxicity.

Metástasis de origen sistémico en Otorrinolaringología / Metastases of systemic origin in Otorhinolaryngology

Introducción. En las vías aéreo-digestivas superiores el cáncer siempre es primitivo; éste cáncer es muy frecuente, pero existen cánceres secundarios de extrema rareza. Desarrollo. Se estudian los casos propios, algunos ya publicados: cánceres de riñón de cáncer de mama en hueso temporal y se revisa la bibliografía sobre estas raras metástasis. Conclusiones. Ante todo cáncer otorrinolaringológico hay que realizar una historia detallada del paciente sobre todo investigando anteriores neoplasias. Muy especialmente estudiar y revisar antecedentes de tumores renales de mama y de próstata en cuanto a tumor primitivo y en cuanto a órganos receptor de las metástasis, los senos paranasales y el hueso temporal. El problema difícil es cuando el tumor primitivo existe y no ha sido diagnosticado. Por ello, en todo cáncer de hueso temporal o de senos paranasales debemos antes de emprender ningún tratamiento, practicar un examen de riñón, próstata y mama y de todos los demás órganos supra o infradiafragmáticos en los que podamos sospechar una tumoración. El pronóstico de estas metástasis es muy malo, prácticamente siempre mortal, por lo que muchas veces en vez de tratamientos más agresivos serán sólo paliativos (AU)

[Metastasis of systemic origin in otorhinolaryngology]. / Metástasis de origen sistémico en otorrinolaringología.

INTRODUCTION: In the upper respiratory-digestive tract cancer is always primary. Such cancer is very common, but other extremely rare secondary cancers may be found. DEVELOPMENT: We studied our own patients and some published in the literature: cancer of the kidney with metastases in the paranasal sinuses and cancer of the breast metastasizing to the temporal bone. We review the bibliography on these rare metastases. CONCLUSIONS: In all cases of otorhinolaryngological cancer a detailed history should be taken, with special reference to previous neoplasms. It is particularly important to study and review any history of renal, breast or prostate tumors with regard to the primary tumor and the receptor organs of metastases, the paranasal sinuses and temporal bones. The most difficult problem occurs when the primary tumor is present but undiagnosed. Therefore, in all cases of cancer of the paranasal sinuses and temporal bones, before treatment is started the kidney, prostate, breast and other organs above and below the diaphragm where tumor may be present should be examined. The prognosis of these metastases, which are almost always fatal, is very poor so that often treatment is only palliative rather than aggressive.

The benign acute epidural haematoma.

The Authors propose a new approach to the treatment and prognostic evaluation of post-traumatic supratentorial acute epidural haematoma (PSAEH). As far as this lesion is concerned a group of patients with a favourable prognosis and without indications for a surgical treatment may be identified. To this purpose, the clinical picture, characterized by a slight symptomatology undergoing a regression phase (stupor, headache, etc.) and a skull CT-scan, characterized by a slight shift of the middle line structures and by the volume of haematoma less than 55 cc, are important aids.

Late outcome of operations for supratentorial convexity meningiomas. Report on 207 cases.

Brief remarks on the immediate outcome of operations on 207 convexity meningiomas are followed by a fuller discussion of the late sequelae, the problem of recurrences and relevance of histology, and the persistence or de novo onset of epilepsy. While the immediate outcome is more than satisfactory, there is still room for improvement in the late outcome of surgical treatment for this category of intracranial tumor.

Immediate and late outcome of operations for Parasagittal and falx meningiomas. Report of 342 cases.

The immediate results of surgery--for the most part radical surgery--in 342 cases of parasagittal and falx meningiomas are presented. The late outcome in 317 survivors observed for at least five years and possible ways of avoiding them are discussed with special reference to recurrences and disabling sequels.

Gliomas and occupational exposure to carcinogens: case-control study.

Patients with gliomas of the central nervous system hospitalized during the period January 1979--March 1980 at the Neurological Institute C. Besta of Milan were compared with controls admitted to the Institute in the same period for nonneoplastic neurologic diseases or benign tumors. The comparison was based on occupational history, smoking habits, and alcohol consumption. Two analyses were carried out: the first by case-control pairs matched for age, sex, and residence; the second by age, sex, and residence stratification. Patients with glioma were more likely than controls to have worked in agricultural activities and showed a relative risk of 5.0 (p = 0.043) in the matched analysis and 1.9 (p = 0.113) in the analysis by stratification. This high risk was confined to those who performed agricultural work after 1960, suggesting a possible etiologic role of exposure to organic pesticides, fertilizers, and herbicides, which have only recently been commonly used in Italy. No significant difference was observed between cases and controls in regard to other analyzed occupations and habits.

Meningiomas of the lateral ventricles. Neuroradiological and surgical considerations in 18 cases.

The clinical and neuroradiological findings and the surgical results in a series of 18 patients with meningiomas of the lateral ventricles, operated on over a 23-year period, are described. This experience is compared with previously reported series and the following conclusions are drawn: 1) these tumors have no characteristic symptomatology; 2) the preoperative diagnosis should be reached by means of both computerized tomography and carotid and vertebral angiography; 3) the safest surgical approach is through a sagittal paramedian parieto-occipital cortical incision; and 4) piecemeal removal is crucial for achieving total extirpation of the tumor with minimum damage of the surrounding brain tissue and for careful intraoperative hemostasis.

Estudio abierto con lorazepan endovenoso como medicacion preanestesica. / Open study with endovenous lorazepan as preanesthetic medication

Se efectuo un estudio abierto en 52 pacientes quirurgicos de ambos sexos (14 hombres y 38 mujeres) con una edad promedio de 36,9 mas o menos 14,9 anos, con 4 mg de lorazepan, administrados por via endovenosa como medicacion preanestesica, valorandose el efecto ansiolitico y amnesico de la droga. Se destacaron el optimo efecto ansiolitico-tranquilizante y su accion sobre la memoria: amnesia anterograda sin efectos significativos sobre los parametros vitales estudiados. No se registraron efectos secundarios de importancia

Estudio abierto con lorazepan endovenoso como medicacion preanestesica. / Open study with endovenous lorazepan as preanesthetic medication

Se efectuo un estudio abierto en 52 pacientes quirurgicos de ambos sexos (14 hombres y 38 mujeres) con una edad promedio de 36,9 mas o menos 14,9 anos, con 4 mg de lorazepan, administrados por via endovenosa como medicacion preanestesica, valorandose el efecto ansiolitico y amnesico de la droga. Se destacaron el optimo efecto ansiolitico-tranquilizante y su accion sobre la memoria: amnesia anterograda sin efectos significativos sobre los parametros vitales estudiados. No se registraron efectos secundarios de importancia